Surgical Management of Endocrine Disorders

  • Joseph B. Lillegard
  • Travis J. McKenzie
  • Geoffrey B. ThompsonEmail author


The twentieth century saw rapid advances in the surgical management of endocrine and endocrine-related neoplastic diseases. High cure rates along with low perioperative morbidity have resulted from an emphasis on specialized training and new techniques, as well as improvements in diagnosis, imaging, and surgical pathology.

This chapter will focus on the surgical management of endocrine disorders that involve the thyroid, parathyroid, adrenal, pituitary glands, and the gastroenteropancreatic system. These endocrine organs are subject to the development of tumors, hyperplasia, and other derangements that are many times amenable to surgery. Each section of this chapter will present a specific endocrine organ followed by its respective set of pathologic derangements, diagnostic approaches, and treatments modalities.


Endocrine disorders Thyroid Parathyroid Adrenal Pituitary glands Gastroenteropancreatic system 


  1. 1.
    Gharib H (1997) Changing concepts in the diagnosis and management of thyroid nodules. Endocrinol Metab Clin North Am 26:777–800CrossRefPubMedGoogle Scholar
  2. 2.
    AACE (1996) Clinical Practice guidelines for the diagnosis and management of thyroid nodules. Endocr Pract 2:78–84Google Scholar
  3. 3.
    Hadi M, Gharib J, Goellner JR, van Heerden JA (1997) Has fine-needle aspiration biopsy changed thyroid practice? Endocrinol Pract 3:9–13Google Scholar
  4. 4.
    O’Brien T, Gharib H, Suman V, van Heerden JA (1992) Treatment of toxic solitary thyroid nodules: Surgery versus radioactive iodine. Surgery 112:1166–1170PubMedGoogle Scholar
  5. 5.
    Jensen M, Gharib H, Naessens J, van Heerden JA, Mayberry WE (1986) Treatment of toxic multinodular goiter (Plummer’s disease): Surgery or radioiodine? World J Surg 10:673–680CrossRefPubMedGoogle Scholar
  6. 6.
    Patwardhan NA, Moront M, Rao S, Rossi S, Braverman LE (1993) Surgery still has a role in Graves’ hyperthyroidism. Surgery 114:1108–1113PubMedGoogle Scholar
  7. 7.
    Pledge S, Bessell EM, Leach IH, Pegg CA, Jenkins D, Dowling F, Moloney A (1996) Non-Hodgkin’s lymphoma of the thyroid: A retrospective review of all patients diagnosed in Notthinghamshire from 1973 to 1992. Clin Oncol 8:371–375CrossRefGoogle Scholar
  8. 8.
    Lin JD, Weng HF, Ho YS (1998) Clinical and pathologic characteristics of secondary thyroid cancer. Thyroid 2:149–153CrossRefGoogle Scholar
  9. 9.
    Thyroid Carcinoma Task Force (2001) AACE/AAES medical/surgical guidelines for clinical practice management of thyroid carcinoma. Endocr Pract 7:203–220Google Scholar
  10. 10.
    Grebe SKG, Hay ID (1997) Follicular cell-derived thyroid carcinomas. Cancer Treat Res 89:91–140PubMedGoogle Scholar
  11. 11.
    McIver B, Hay ID, Giuffrida DF, Dvorak CE, Grant CS, Thompson GB, van Heerden JA, Goellner JR (2001) Anaplastic thyroid carcinoma: A 50-year experience at a single institution. Surgery 130:1028–1034CrossRefPubMedGoogle Scholar
  12. 12.
    Hay ID, Grant CS, Taylor WF, McConahey WM (1987) Ipsilateral lobectomy versus bilateral resection in papillary thyroid carcinoma: A retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 102:1088–1095PubMedGoogle Scholar
  13. 13.
    Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS (1993) Predicting outcome in papillary thyroid carcinoma: Development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058PubMedGoogle Scholar
  14. 14.
    Stulak JM, Grant CS, Farley DR, Thompson GB, Hay ID, Reading CC, Charboneau JW (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 141:489–496CrossRefPubMedGoogle Scholar
  15. 15.
    Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA, Goellner JR (1998) Unilateral total lobectomy: Is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery 124:958–966PubMedGoogle Scholar
  16. 16.
    Herrera M, Grant CS, van Heerden JA, Fitzpatrick LA (1992) Parathyroid autotransplantation. Arch Surg 127:825–829PubMedGoogle Scholar
  17. 17.
    McIver B, Hay ID (2001) Postoperative management of differentiated thyroid carcinoma. In: Doherty GM, Skogseid B (eds) Surgical endocrinology. Lippincott, Williams & Wilkins, Philadelphia, pp 87–108Google Scholar
  18. 18.
    Cooper DS, Specker B, Ho M, Ho M, Sperling M, Ladenson PW, Ross DS, Ain KB, Bigos ST, Brierley JD, Haugen BR, Klein I, Robbins J, Sherman SI, Taylor T, Maxon HR III (1998) Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: Results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid 8:737–744CrossRefPubMedGoogle Scholar
  19. 19.
    Paphavasit A, Thompson GB, Hay ID, Grant CS, van Heerden JA, Ilstrup DM, Schleck C, Goellner JR (1997) Follicular and Hurthle cell thyroid neoplasms: Is frozen section evaluation worthwhile? Arch Surg 132:674–680PubMedGoogle Scholar
  20. 20.
    van Heerden JA, Hay ID, Goellner JR, Salamao D, Ebersold JR, Bergstralh EJ, Grant CS (1992) Follicular thyroid carcinoma with capsular invasion alone: A non-threatening malignancy. Surgery 112:1130–1136PubMedGoogle Scholar
  21. 21.
    Gimm O, Sutter T, Dralle H (2001) Diagnosis and therapy of sporadic and familial medullary thyroid carcinoma. J Cancer Res Clin Oncol 127:156–165CrossRefPubMedGoogle Scholar
  22. 22.
    Yeung GH (1998) Endoscopic surgery of the neck: A new frontier. Surg Laparosc Endosc 8:227–232CrossRefPubMedGoogle Scholar
  23. 23.
    van Heerden JA, Grant CS (1991) Surgical treatment of primary hyperparathyroidism: An institutional perspective. World J Surg 15:688–692CrossRefPubMedGoogle Scholar
  24. 24.
    Thompson GB, Grant CS, Perrier ND, Harman CR, Hodgson SF, Ilstrup DM, van Heerden JA (1999) Reoperative parathyroid surgery in the era of sestamibi scanning and intraoperative parathyroid hormone monitoring. Arch Surg 134:699–705CrossRefPubMedGoogle Scholar
  25. 25.
    Sandelin K, Auer G, Bondeson L, Grimelius L, Farnebo LO (1992) World J Surg 116:724–731CrossRefGoogle Scholar
  26. 26.
    Bilezikian J, Potts JJ, Fuleihan G-H, Kleerekoper M, Neer R, Peacock M, Rastad J, Silverberg SJ, Udelsman R, Wells SA (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 87:5353–5361CrossRefPubMedGoogle Scholar
  27. 27.
    Denham DW, Norman J (1998) Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg 186:293–305CrossRefPubMedGoogle Scholar
  28. 28.
    Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Snigh B, Boyle JO, Shah JP, Brennan MF, Kraus DH (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832CrossRefPubMedGoogle Scholar
  29. 29.
    Udelsman R (2002) Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–670CrossRefPubMedGoogle Scholar
  30. 30.
    Norman J, Chheda H (1997) Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 122:998–1004CrossRefPubMedGoogle Scholar
  31. 31.
    Fukagawa M, Kurokawa K (1997) Pathogenesis and medical treatment of secondary hyperparathyroidism. Semin Surg Oncol 13:73–77CrossRefPubMedGoogle Scholar
  32. 32.
    Kilgo MS, Pirsch JD, Warner TF, Starling JR (1998) Tertiary hyperparathyroidism after renal transplantation: Surgical strategy. Surgery 124:677–683CrossRefPubMedGoogle Scholar
  33. 33.
    Young WF Jr (2000) Management approaches to adrenal incidentalomas: A view from Rochester, Minnesota. Endocrinol Metab Clin North Am 29:159–185CrossRefPubMedGoogle Scholar
  34. 34.
    Thompson GB, Grant CS, van Heerden JA, Schlinkert RT, Young WF Jr, Farley DR, Ilstrup DM (1997) Laparoscopic versus open adrenalectomy: A case-control study of 100 patients. Surgery 122:1132–1136CrossRefPubMedGoogle Scholar
  35. 35.
    Young WF Jr (1997) Pheochromocytoma and primary aldosteronism: Diagnostic approaches. Endocrinol Metab Clin North Am 26:801–827CrossRefPubMedGoogle Scholar
  36. 36.
    Young WF Jr, Stanson AW, Grant AW, Grant CS, Thompson GB, van Heerden JA (1996) Primary aldosteronism: Adrenal venous sampling. Surgery 120:913–920CrossRefPubMedGoogle Scholar
  37. 37.
    Dinneen SF, Carney JA, Carpenter PC, Grant CS, Young WF Jr (1995) ACTH-independent Cushing’s syndrome: Bilateral cortisol-producing adrenal adenomas. Endocr Pract 1:77–81PubMedGoogle Scholar
  38. 38.
    Vella A, Thompson GB, Grant CS, van Heerden JA, Farley DR, Young WF Jr (2001) Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 86:1596–1599CrossRefPubMedGoogle Scholar
  39. 39.
    Norman JA (1997) Adrenal tumors. In: De Vita VT, Hellman S, Rosenberg SA (eds) Cancer: Principles and practice of oncology. Lippincott-Raven Publishers, PhiladelphiaGoogle Scholar
  40. 40.
    Aniszewski JP, Young WF Jr, Thompson GB, Grant CS, van Heerden JA (2001) Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. World J Surg 25:934–940CrossRefPubMedGoogle Scholar
  41. 41.
    Thompson GB, van Heerden JA, Martin JK, Schutt AJ, Ilstrup DM, Carney JA (1985) Carcinoid tumors of the gastrointestinal tract: Presentation, management and prognosis. Surgery 98:1054–1062PubMedGoogle Scholar
  42. 42.
    Soreide JA, van Heerden JA, Thompson GB, Schleck C, Ilstrup DM, Churchward M (2000) Gastrointestinal carcinoid tumors: Long-term prognosis for surgically treated patients. World J Surg 24:1431–1436CrossRefPubMedGoogle Scholar
  43. 43.
    Akerstrom G (1992) Carcinoid tumors of the gut: Diagnosis and treatment. Acta Chir Austriaca 24:88–93CrossRefGoogle Scholar
  44. 44.
    Siperstein AE, Rogers SJ, Hansen PD, Gitomirsky A (1997) Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases. Surgery 122:1147–1155CrossRefPubMedGoogle Scholar
  45. 45.
    Jetmore J, Ray J, Gathright JB Jr, McMullen KM, Hicks TC, Timmcke AE (1992) Rectal carcinoid tumors: The most frequent carcinoid tumor. Dis Colon Rectum 35:717–725CrossRefPubMedGoogle Scholar
  46. 46.
    Gough DB, Thompson GB, Crotty T, Donohue JH, Kvols L, Carney JA, Grant CS, Nagorney DM (1994) Diverse clinical and pathologic features of gastric carcinoid and the relevance of hypergastrinemia. World J Surg 18:473–480CrossRefPubMedGoogle Scholar
  47. 47.
    Jensen RT, Norton JA (1998) Endocrine tumors of the pancreas. In: Feldman M, Scharschmidt BF, Sleisenger MH (eds) Gastrointestinal and liver disease, 6th edn. W.B. Saunders, Philadelphia, pp 871–894Google Scholar
  48. 48.
    Thompson NW (1998) Current concepts in the surgical management of multiple endocrine neoplasia type 1 pancreatic-duodenal disease. Results in the treatment of 40 patients with Zollinger-Ellison syndrome, hypoglycaemia or both. J Intern Med 243:495–500CrossRefPubMedGoogle Scholar
  49. 49.
    Service, F.J (1999) Diagnostic approach to adults with hypoglycemic disorders. Endocrinol Metab Clin North Am 28:519–532CrossRefGoogle Scholar
  50. 50.
    Service FJ, Natt N, Thompson GB, Grant CS, van Heerden JA, Andrews JC, Lorenz E, Lloyd RV (1999) Non-insulinoma pancreatogenous hypoglycemia: A novel syndrome of hyperinsulinemic hypoglycemia in adults independent of mutations in Kir6.2 and SUR1 Genes. J Clin Endocrinol Metab 84:1582–1589CrossRefPubMedGoogle Scholar
  51. 51.
    Thompson GB, Service FJ, Andrews JC, Lloyd RV, Natt N, van Heerden JA, Grant CS (2000) Noninsulinoma pancreatogenous hypoglycemia syndrome: an update in 10 surgically treated patients. Surgery 128:937–935CrossRefPubMedGoogle Scholar
  52. 52.
    Fatourechi V, Wermers RA (1996) Glucagon-producing tumors and glucagonoma. The Endocrinologist 6:285–293CrossRefGoogle Scholar
  53. 53.
    van Heerden JA, Thompson GB (1993) Islet cell tumors of the pancreas. In: Trede M, Carter D (eds) Surgery of the pancreas. Churchill Livingstone, London, pp 545–561Google Scholar
  54. 54.
    Thompson GB (2003) Islet cell tumors. In: Kelly KA, Sarr MG, Hinder RA (eds) Mayo clinic gastrointestinal surgery. Elsevier Science, Philadelphia, pp 299–320Google Scholar
  55. 55.
    Thompson GB, van Heerden JA, Grant CS, Carney JA, Ilstrup DM (1988) Islet cell carcinomas of the pancreas: A twenty-year experience. Surgery 104:1011–1017PubMedGoogle Scholar
  56. 56.
    Musunuru S, Chen H, Rajpal S, Stephani N, McDermott JC, Holen K, Rikkers LF, Weber SM (2006) Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg 141:1000–1004CrossRefPubMedGoogle Scholar
  57. 57.
    Olausson M, Friman S, Herlenius G, Cahlin C, Nilsson O, Jansson S, Wangberg B, Ahlman H (2007) Orthotopic liver or multivisceral transplantation as treatment of metastatic neuroendocrine tumors. Liver Transpl 13:327–333CrossRefPubMedGoogle Scholar
  58. 58.
    Laws ER, Fode NC, Redmond MJ (1985) Transsphenoidal surgery following unsuccessful prior therapy: An assessment of benefits and risks in 158 patients. J Neurosurg 63:823–829CrossRefPubMedGoogle Scholar
  59. 59.
    Nasseri SS, Kasperbauer JL, Strome SE, McCaffrey TV, Atkinson JL, Meyer FB (2001) Endoscopic transnasal pituitary surgery: Report of 180 cases. Am J Rhinol 15:281–287PubMedGoogle Scholar
  60. 60.
    Swearingen B, Biller BMK, Barker FG II, Katznelson L, Grinspoon S, Klibanski A, Zervas NT (1999) Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 130:821–824PubMedGoogle Scholar
  61. 61.
    Ikeda H, Jokura H, Yoshimoto T (2001) Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg 95:285–291CrossRefPubMedGoogle Scholar
  62. 62.
    Williams PW (1894) Notes on diabetes treated with extract and by grafts of sheep’s pancreas. BMJ 2:1303–1304Google Scholar
  63. 63.
    Miszata-Lane H, Mirbolooki M, Shapiro J, Lakey JR (2006) Stem cell sources for clinical islet transplantation in type 1 diabetics: Embryonic and adult stem cells. Med Hypotheses 67:909–913CrossRefGoogle Scholar
  64. 64.
    Witkowski P, Zakai SB, Rana A, Sledzinski Z, Hardy MA (2006) Pancreatic islet transplantation, what has been achieved since Edmonton break-through. Ann Transpl Surg 2:5–13Google Scholar
  65. 65.
    Balsiger BM, Kennedy FP, Abu-Lebdeh HS, Collazo-Clavell M, Jensen MD, O’Brian T, Hensrud DD, Dinneen SF, Thompson GB, Que FG, Williams DE, Clark MM, Grant JE, Frick MS, Mueller RA, Mai JL, Sarr MG (2000) Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clin Proc 75:673–680CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Joseph B. Lillegard
  • Travis J. McKenzie
  • Geoffrey B. Thompson
    • 1
    Email author
  1. 1.Department of SurgeryMayo ClinicRochesterUSA

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